How accurate are diagnostic tools for autism spectrum disord | Figure 1

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How accurate are diagnostic tools for autism spectrum disorder (ASD) in preschool children?

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Cochrane Review; 13 studies (2900 children)

Key findings

Results were available for three tools: Autism Diagnostic Observation Schedule (ADOS; Modules 1 and 2), (Childhood Autism Rating Scale (CARS); Autism Diagnostic Interview-Revised (ADI-R).

If instruments were applied to 1000 children, 740 of whom had ASD, then 696, 592, and 385 children would be correctly identified by ADOS, CARS, and ADI-R, respectively, whereas 52, 31, and 42 children without ASD would be incorrectly classified as having ASD.

Of 260 children without ASD, 208, 229, and 218 would be correctly classified by ADOS, CARS, and ADI-R, respectively, whereas 44, 148, and 355 children with ASD would be incorrectly classified as not having ASD.

One publication looked at using ADI-R together with ADOS. Using both tools together was no more accurate than use of ADOS alone.

Conclusions:

Problems with how some studies were conducted and conflicts of interest may result in ADOS, CARS, and ADI-R appearing more accurate than they really are.

Findings suggest that ADOS is best for not missing children who have ASD and is similar to CARS and ADI-R in not falsely diagnosing ASD in a child who does not have ASD.

ADOS has acceptable accuracy in populations with a high prevalence of ASD. However, overdiagnosis is likely if the tool is used in populations with a lower prevalence of ASD.

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